4093 — Weight Gain of 5 Pounds Associated with Hospital Readmission in Rural Heart Failure Patients

Lead/Presenter: Linda Park, 
All Authors: Park LG (San Francisco Veterans Affairs; University of California, San Francisco) Dracup KA (University of California, San Francisco) Whooley MA (San Francisco Veterans Affairs; University of California, San Francisco) Howie Esquivel J (University of California, San Francisco)

Objectives:
Health care providers regularly counsel patients with heart failure (HF) that weight gain is a critical indicator of disease exacerbation; however, there is lack of evidence that describes the health-related sequelae. The aims of this study were to compare weight patterns and change in rural-dwelling patients with HF who did and did not have hospital admission and ED visits.

Methods:
This is a secondary analysis of a 3-arm randomized controlled trial with two intervention groups (Fluid Watchers LITE and PLUS) and usual care. The two intervention groups were given daily diaries for 2 years to track daily weight, HF symptoms, and response to symptom changes. The mean age was 66 ± 13; 58% were male. Of the 264/393 (67%) patients who completed diaries, we used descriptive statistics to compare the percentage and number of times a patient ever gained 5+ lbs in a week with different events (ED and hospitalization) using linear mixed models.

Results:
Patients with HF-related hospital admissions had more instances of 5+ lb weight gain in a week as compared to non-hospitalized patients. The same trend was found for ED vs non-ED patients. In examining the slope of weight gain, patients had an average increase of 1.7 lbs per week prior to hospital admission (p = 0.05) and 0.5 lb per week prior to ED visit (p = 0.37). These data compare to a flat weight trajectory with an average slope of 0 lbs per week for all patients over 2 years.

Implications:
Patients tended to be on an increasing weight trajectory before hospitalization or ED visit. There was a significant association with an incremental weight gain as low as 1.7 lbs per week and hospital admission in rural patients with HF.

Impacts:
These data support the long-held belief that weight gain of 5 pounds in one week portends negative events. Diary use to track weight as part of HF self-care should be considered since patient report of weight gain can initiate treatment changes to prevent HF exacerbation.